Introduction

For an intro­duc­tion to PrEP, how it works as well as its pros and cons, we refer you to our PrEP FAQs. You will find infor­ma­tion there to help you decide whether PrEP is right for you. You can also find out how a con­tin­u­ous or peri­od­ic (inter­mit­tent) dos­ing sched­ule works.

This PrEP­nu pro­to­col is based on the offi­cial Dutch PrEP guide­line adopt­ed by the Dutch Asso­ci­a­tion of HIV-treat­ing Physi­cians (NVHB) and the Physi­cians’ Expert Group for STI, HIV, sex­u­al­i­ty and among oth­er organ­i­sa­tions. It is advis­able to fol­low this (broad­er) guide­line, ide­al­ly with the assis­tance of your doc­tor. There­fore, we rec­om­mend you to print out the offi­cial Dutch PrEP guide­line, bring it with you to your doc­tor and open to the table on page 12. This table sum­maris­es how you can use PrEP safe­ly and which tests are required before you can start tak­ing PrEP.

NOTE: PrEP is an extreme­ly effec­tive mea­sure for pre­vent­ing HIV. This has been sci­en­tif­i­cal­ly proven. How­ev­er, using PrEP is NOT a 100% guar­an­tee for pro­tec­tion (this applies to all pre­ven­tive mea­sures, includ­ing con­doms).

 

Required medical testing for PrEP users

(Under­lined items are cru­cial for pre­vent­ing major health risks; oth­er items are less impor­tant but we still strong­ly rec­om­mend them.)

 

Before starting PrEP:

Kidney function test + urine dipstick test for protein and glucose levels in urine

 ‣ PrEP is not suit­able for peo­ple with impaired kid­ney func­tion. This must be ruled out by doing a kid­ney func­tion test before you start tak­ing PrEP. You can request this test from your doc­tor, we also expect that the Pub­lic Health Ser­vice of Ams­ter­dam (GGD) will offer this test for free soon. The test deter­mines the cre­a­ti­nine lev­el in your blood; your doc­tor can also per­form a test on the pro­tein and glu­cose lev­els in your urine. These tests are inex­pen­sive and will not have a major impact on your health insur­ance deductible excess.

Hepatitis B virus test

 ‣ This test is to rule out an active Hepati­tis B infec­tion. It’s still impor­tant to have your doc­tor per­form this test even if you are com­plete­ly vac­ci­nat­ed for Hepati­tis B. The vac­ci­na­tion is not com­plete­ly effec­tive and there is a risk of becom­ing ill if you unknow­ing­ly have Hepati­tis B and start tak­ing PrEP.

     ‣ The Hepati­tis B test is not required if you can show anti­body test results from the past that prove you are actu­al­ly immu­nised against Hepati­tis B. Once you are immune to Hepati­tis B, you will always be immune to it. Proof of vac­ci­na­tion alone is NOT suf­fi­cient.

HIV test (4th generation HIV combination test) + Screening for other STIs: Chlamydia, Gonorrhoea, Syphilis in the throat, anus and urine

 ‣ It’s extreme­ly impor­tant that you do not have HIV when you start tak­ing PrEP because oth­er­wise the HIV virus can devel­op resis­tance to the active ingre­di­ents in PrEP. That’s why you must be test­ed for HIV by your doc­tor or the Pub­lic Health Ser­vice (GGD), no longer than two weeks before you start tak­ing PrEP. This has to be a 4th gen­er­a­tion HIV test. It takes at least a few days for you to receive the results. If you are test­ed by your doc­tor or the GGD (g. via mantotman.nl), then you will auto­mat­i­cal­ly receive this new type of HIV test. An HIV rapid test, which is usu­al­ly done using a fin­ger prick with results being pro­vid­ed imme­di­ate­ly, is NOT suf­fi­cient.

Be tested for STIs every 3 months

 ‣ We strong­ly rec­om­mend you to get test­ed for STIs, includ­ing HIV and Hepati­tis C, before start­ing PrEP and once every 3 months after­wards. Hepati­tis C was found rel­a­tive­ly often among peo­ple who signed up for the AMPrEP study. That’s why we advise you to be test­ed by your doc­tor using a Hepati­tis C anti­body test.

 ‣ Note: HIV and STI tests per­formed by your doc­tor may not be reim­bursed by your health insur­er. To avoid heavy costs, you can be test­ed for HIV and STIs by the GGD or by the Test­lab of Man tot Man and then let your doc­tor con­duct the oth­er tests. The GGD does not auto­mat­i­cal­ly test for Hepati­tis B and C.

Check for interactions with medications you already use

 ‣ PrEP inter­acts with some oth­er med­ica­tions (for exam­ple, with Valaci­clovir, a her­pes med­ica­tion). If you are cur­rent­ly using oth­er med­ica­tions, it’s impor­tant to check first to see whether these will inter­act with PrEP before you start tak­ing PrEP.

 ‣ You can check with your doc­tor or phar­ma­cists on hivdruginteractions.org. Fill in ‘Teno­fovir-DF’ and ‘Emtric­itabine (FTC)’ at the HIV Drugs sec­tion, then enter the med­ica­tions you’re cur­rent­ly using (the active ingre­di­ent, not the brand name; see the insert that comes with your med­ica­tions) under ‘Co-med­ica­tions’. The web­site will then indi­cate whether or not these med­ica­tions will inter­act with PrEP.

 ‣ If you have to start tak­ing new med­ica­tions after you’ve start­ed tak­ing PrEP, then check again with your doc­tor or phar­ma­cists to make sure no inter­ac­tions will occur, also be sure to inform your doc­tor that you are using PrEP.

 

1 month after starting PrEP:

Kidney function test

 ‣ In rare cas­es, PrEP caus­es impaired kid­ney func­tion. That’s why it’s impor­tant to test your kid­ney func­tion once again 1 month after you start tak­ing PrEP.

HIV combination test (4th generation ELISA); see above

 

Every 3 months after starting PrEP:

HIV combination test (4th generation ELISA); see above
STI screening: Chlamydia, Gonorrhoea, Syphilis in the throat, anus and urine

 

Every 6 months after starting PrEP:

Kidney function test
✯ Hepatitis C virus test